Male, age 25. Initial Visit: August 24 ^th, 2009

Chief Complaint: A sudden burning hot, painful sensation and redness in the sclera for three days, becoming worse one day prior to treatment.

History: Three days prior to treatment, a sudden burning, painful sensation and redness appeared in the sclera. The patient self-administered chloramphenicol eye drops, with no relief to symptoms. The symptoms became aggravated one day prior to treatment. The patient prefers spicy food in his daily diet.

Signs and Symptoms: Burning hot sensation, continuous tearing, redness and swelling in the eyelid and the sclera with blood spillage, a dry mouth and restlessness, constipation and reddish urine. The tongue was red with a yellow and slightly greasy coating; the pulse was fast and forceful.

The main characteristics of this patient were a sudden onset of a burning and painful sensation of the right eye, and redness and swelling in the sclera with blood spillage. Other symptoms included tearing, redness and swelling in the palpebrae conjunctiva, thirst and restlessness, and constipation with reddish urine. The tongue was red with a slightly yellow greasy coating, and the pulse was fast and forceful.

The patient was a 25-year-old, young man with a strong preference for hot and spicy foods. There was an accumulation of heat in the spleen and stomach, and then he was attacked by epidemic pestilential qi. The combination of internal and external evils atacking upwards to the sclera caused blood spillage; while thirst and restlessness, constipation and reddish urine, the red tongue with a slightly sticky yellow coating and the fast forceful pulse are signs of intense epidemic heat with evil toxins.

The disease location was the sclera, which belongs to the “qi wheel” and is associated with the lung organ. The presenting patern is epidemic heat injuring the collaterals, an excess patern with toxic heat.

WM diagnosis: Epidemic hemorrhagic conjunctivitis (right eye)

TCM diagnosis: Heaven-current red eye (right eye) due to epidemic heat atacking upward to damage the collaterals

The disease pattern for this case belongs to heat and excess. The root etiology is epidemic heat and evil toxins attacking upwards to the sclera and collaterals, resulting in blood spillage. Based on the principle of draining excess and cooling heat, treatment should focus on treating the epidemic heat and evil toxins frst.

Principles: Clear heat, resolve heat, cool blood and dissipate toxins

Formula: Modified Xī Jiăo Dì Huāng Tāng (Rhinoceros Horn and Rehmannia Decoction) and Yín Qiào Săn (Lonicera and Forsythia Powder)

[犀角地黄汤合银翘散加减]

[Formula Analysis]

Shuĭ niú jiăo cools the blood, clears heat, resolves toxins, pacifies fire, descends heat and stops bleeding.

Shēng dì huáng cools the blood, nourishes the yin and generates fluids.

Mŭ dān pí, chì sháo and zĭ căo clear heat, cool the blood, move blood and dissipate stasis.

Jīn yín huā and lián qiào disperse wind, clear heat and resolve toxins. Their light and cool nature vents heat from the ying level through the qi level.

Zhú yè and lú gēn clear heat and generate fluids.

Bò he and jīng jiè release the exterior and dissipate evil to strengthen the releasing and dispersing action of the formula.

Shēng gān căo clears heat, resolves toxins and harmonizes the actions of the other medicinals.

Eye drops: 0.2% Heartleaf Houtuynia Medicinal Eye Drops, 6 times per day, or once every hour for severe cases. It may also use antiviral eye drops combined with antibiotic eye drops.

Eye wash methods: Decoct dà qīng yè (Folium Isatidis) 20g, jīn yín huā (Flos Lonicerae Japonicae) 15g, pú gōng yīng (Herba Taraxaci) 30g, jú huā (Flos Chrysanthemi) 15g and other heat-clearing and toxin-resolving herbs to fumigate and wash the affected eye, 2-3 times per day.

Main Points: LI 4 ( hé gŭ), GB 20 ( fēng chí), BL 2 ( cuán zhú), SJ 23 ( sī zhú kōng)

Supplementary Points: LI 11 ( qū chí), BL 1 ( jīng míng), tài yáng (EX-HN5), SJ 5 ( wàiguān)

Method: Select 2 main points every day along with 2-3 supplementary points, alternating the points every other day. Retain the needle for 20 min afer arrival of qi.

Techniques: The draining needling technique was mainly applied.

After three days of treatment, the redness and blood spillage in the sclera were reduced and the swelling in the sclera and dry stools with constipation had resolved. This indicated that most of the toxic heat had been eliminated.

However, the redness and blood spillage into the sclera with burning hot sensation and tearing in the right eye, thirst, reddish urine, a red tongue with a yellow and slightly greasy coating and the rapid, forceful pulse were still present. This indicated the presence of residual epidemic heat and evil toxins, so the above formula was continued with zĭ căo removed and huò xiāng gĕng (Caulis Agastachis) 20g added.

[Formula Analysis]

Because this case occurred during the summer and due to the slightly yellow greasy tongue coating, huò xiāng gĕng was added to relieve summerheat, transform dampness, and harmonize the stomach. Because the redness and blood spillage into the sclera were reduced, zĭ căo was removed to prevent the overall formula from becoming too cold.